Testicular Torsion

The testicular torsion is an emergency situation due to the rotation of the testis and the consequent strangulation of its blood supply. When symptoms of acute testicular pain and testicular swelling, nausea and vomiting. The diagnosis is made by physical examination and color Doppler secured. Treatment consists of immediate manual Detorquierung with subsequent surgical intervention.

Abnormal development of the tunica vaginalis and the testicle may be incomplete fixation of the testis to the tunica vaginalis (bell clapper deformity, abnormal testicular fixation leads to torsion.) Lead. This anomaly predisposes the testicles to the spontaneous or traumatic twisting around his train. These predisposing abnormality is present all men at about 12%. The twist is most common between 12 and 18 years, with a second peak in infancy. In men> 30 years it is rather rare. It is more common in the left testicle.

The testicular torsion is an emergency situation due to the rotation of the testis and the consequent strangulation of its blood supply. When symptoms of acute testicular pain and testicular swelling, nausea and vomiting. The diagnosis is made by physical examination and color Doppler secured. Treatment consists of immediate manual Detorquierung with subsequent surgical intervention. Abnormal development of the tunica vaginalis and the testicle may be incomplete fixation of the testis to the tunica vaginalis (bell clapper deformity, abnormal testicular fixation leads to torsion.) Lead. This anomaly predisposes the testicles to the spontaneous or traumatic twisting around his train. These predisposing abnormality is present all men at about 12%. The twist is most common between 12 and 18 years, with a second peak in infancy. In men> 30 years it is rather rare. It is more common in the left testicle. Abnormal testicular fixation leads to torsion. Typically, the anterior two-thirds of the respective balls of the tunica vaginalis, where liquids can accumulate, covered. The tunica vaginalis attaches itself to the posterolateral surface of the testes and limits their movement in the scrotum. If the fixation is too high (anterior and cranial), the testicle can move more freely and torsion is more likely. A: fixation is normal. B: fixation is too high, so that the testes can twist angles and there is a twist. Symptoms and signs Acute symptoms include sudden onset of severe pain, nausea and vomiting, followed by skrotalem edema and induration. Fever and frequent urination can be added. The testis is sensitive to pressure and can stand tall or horizontal. The contralateral testis may also be horizontal, because the anatomical defects commonly found on both sides. The cremasteric usually absent on the affected side. Sometimes a twist can heal spontaneously and then recur, suggesting a less acute onset. Normally, however, the emergence and resolution of pain in each episode is very fast. Diagnosis Clinical evaluation Often color Doppler sonography, the twist must be detected quickly. Similar symptoms result mainly of a tEpididymitis. In an epididymitis, pain and swelling are usually less acute and occur initially on in the epididymis. However, at two diseases to generalized swelling and sensitivity, making it difficult to distinguish a twist of an epididymitis. The clinical diagnosis is often sufficient to initiate therapeutic measures. An unclear diagnosis can be resolved by immediate imaging methods when they become available. A color Doppler ultrasound of the testes is preferred. The radio isotope analysis of the scrotum may also contribute to the diagnosis, but takes a long time and is therefore less useful. Detorsion therapy Manual operation: Urgent when detorsion is unsuccessful, otherwise optional An attempt immediate manual Detorsion without imaging can be done during the initial investigation; Success is different. Because testes normally rotate inwardly, is rotated at the detorsion the testes to the outside (z. B. is carried out at a detorsion left testicle clockwise from the front side below the testes of view). It may be more than one revolution needed to solve the twist; Pain relief perform the method. In cases of suspected testicular torsion an immediate surgery is indicated because the exploration is the only chance to save the testicle within hours. The chance of obtaining testicular drops from 80-100% after 6-8 h h rapidly to near zero after the 12th Fixation of the contralateral testis is also carried out to prevent a twist on this page. If the manual detorsion is successful, is either a bilateral fixation of the testes. Conclusion A testicular torsion typically causes a sudden outbreak of severe scrotal pain, nausea and vomiting, followed by skrotalem edema and induration. Neither it comes at a testicular torsion in frequent urination or fever, but usually lack the cremasteric. Patients with clinical findings are treated, imaging should be used only in cases with unclear results. The affected testicle should be rotated and outward when this is not possible, arrangements are made for immediate surgery. For more information on American Urological Association Curriculum Acute Scrotum

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